To eliminate TB we need imagination and ambition

Author

Disclosure statement

Madhukar Pai serves on the STAG-TB committee of WHO, Geneva; Scientific Advisory Committee of FIND, Geneva; and Access Advisory Committee of TB Alliance, New York. He serves as the Chair of the Public-Private Mix (PPM) Working Group of the Stop TB Partnership. He has no industry or financial conflicts.

Partners

I recently had chance to attend the first-ever United Nations high-level meeting on tuberculosis. It was an historic opportunity for heads of state to acknowledge the enormous burden of tuberculosis (TB), the world’s leading infectious killer, and to show their commitment to eradicating it by 2030.

Patients with drug-resistant TB have to endure a prolonged (up to two years) and toxic treatment with multiple drugs (more than 14,000 pills) — including painful daily injections that can make people deaf.

The fact that we are still using century-old tools to tackle the biggest killer infection betrays a complete lack of ambition. So, before we can eliminate TB, we must end our lack of ambition. Only when we become more ambitious will our heads of state come around, rally and support us.

A realistic dream

For those who develop TB symptoms, we will offer a rapid, simple triage test. Those with positive triage test results will get a point-of-care molecular diagnosis, followed by confirmatory drug-resistance testing using sequencing.

Soon, rapid, molecular TB tests can be used at the point of care and produce results within an hour, along with information on drug-resistance.(Madhukar Pai), Author provided

Patients will have access to digital technologies that can help them stick to their treatment plan and allow them to make money transfers.

A modern TB service will be free of paper. And, thanks to cloud-based information and communication technologies, TB program staff will be able to monitor the epidemic locally and nationally, as well as offering patients the personalized care and support they need.

Is this modern TB service an unrealistic dream? I don’t think so, because many such tools and solutions already exist, in some form or fashion. They have just failed to come to together to serve those who need them the most. And, for some tools such as a better vaccine and a shorter drug therapy, new investments are urgently needed.

Yes, developing new tools is going to cost money — an additional US$1.3 billion per year. But if the global health community can find a way to fight Ebola with modern tools and technologies, I see no reason for the TB field to be unambitious.

We need to “science the shit” out of TB and this is possible if we make the investments. If each country spends 0.1 per cent of its annual gross domestic expenditure on research and development (GERD) on TB research, the funding gap can be bridged.

Poor quality care kills TB patients

TB care is more than just new tools. We also need to improve the quality of care that we give to persons with TB.

Throughout the report, TB is used as a key example — to illustrate the need to go beyond coverage and focus on quality of care. The authors estimate that half of the annual 946,003 global TB deaths that are amendable to health care occur due to poor quality care. The remaining 476,047 deaths are due to not using health-care services.

TB is often missed because of old tools that are used, such as the microscope.(Madhukar Pai), Author provided (No reuse)

Simulated patient studies, using a methodology developed by our team, in four countries (India, Kenya, China and South Africa) show poor quality of care in both public and private sectors, with the private sector faring worse.

TB patients suffer high costs and long wait times while seeking care and receiving treatment.

In low-resource settings many patients cannot access the tests they need for accurate diagnosis, treatment and a chance of survival. Here, patients wait in the Edna Adan University Hospital in Somalia, 2010.
(Shutterstock)

Tuberculosis has been a problem for decades among Canada’s northern Indigenous population. New data obtained through access to information requests reveals shockingly high TB rates among Nunavut’s infants. Poor data collection indicates the real rates will be even higher.
(Gar Lunney/Library and Archives Canada)